[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7236 Introduced in House (IH)]

<DOC>






117th CONGRESS
  2d Session
                                H. R. 7236

      To amend title XIX of the Social Security Act to expand the 
availability of mental, emotional, and behavioral health services under 
             the Medicaid program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 28, 2022

   Ms. Eshoo (for herself, Mr. Fitzpatrick, and Ms. Blunt Rochester) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
      To amend title XIX of the Social Security Act to expand the 
availability of mental, emotional, and behavioral health services under 
             the Medicaid program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Strengthen Kids' Mental Health Now 
Act of 2022''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Payment parity for pediatric behavioral health services.
Sec. 4. Guidance to States on supporting mental, emotional, and 
                            behavioral health services, and on the 
                            availability of telehealth under Medicaid.
Sec. 5. Ensuring children receive timely access to care.
Sec. 6. Programs to support pediatric behavioral health care.
Sec. 7. Increasing Federal investment in pediatric behavioral health 
                            services.

SEC. 3. PAYMENT PARITY FOR PEDIATRIC BEHAVIORAL HEALTH SERVICES.

    (a) Payment Parity for Pediatric Behavioral Health Services.--
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended--
            (1) in subsection (a)(13)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C), by adding ``and'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) for payment for pediatric mental, emotional, 
                and behavioral health services (as defined in 
                subsection (tt)) furnished on or after the date that is 
                180 days after the date of enactment of this 
                subparagraph and before October 1, 2027, at a rate not 
                less than 100 percent of the payment rate that applies 
                to such providers under part A or B (as applicable) of 
                title XVIII;''; and
            (2) by adding at the end the following new subsection:
    ``(tt) Pediatric Mental, Emotional, and Behavioral Health Services 
Defined.--For purposes of subsection (a)(13)(D), the term `pediatric 
mental, emotional, and behavioral health services' means the following 
services furnished by a health care provider, including hospitals, 
physicians, and other providers determined by the Secretary, for the 
purposes of screening for, diagnosing, or treating a mental, emotional, 
or behavioral health condition, whether furnished in-person or via 
telehealth:
            ``(1) Mental health and substance use disorder screenings.
            ``(2) Mental health development assessments.
            ``(3) Mental health behavior assessments and interventions.
            ``(4) Psychological and neuropsychological testing and 
        assessment.
            ``(5) Mental health primary prevention services.
            ``(6) Mental health and substance use disorder case 
        management services.
            ``(7) School-based mental health and substance use disorder 
        prevention, identification, and treatment services.
            ``(8) Child and adolescent psychiatry and psychology 
        services.
            ``(9) Partial hospitalization services.
            ``(10) Day program services.
            ``(11) Intensive outpatient services.
            ``(12) Eating disorder treatment services.
            ``(13) Outpatient services.
            ``(14) Crisis residential services.
            ``(15) Crisis intervention and stabilization.
            ``(16) Inpatient psychiatric and psychological services.
            ``(17) Individual therapy.
            ``(18) Family therapy.
            ``(19) Group therapy services.
            ``(20) Intensive in-home services.
            ``(21) Peer support services.
            ``(22) Provider-to-provider consultation services involving 
        primary care practitioners sand mental health care specialists, 
        including child and adolescent specialists.
            ``(23) Substance use disorder screening, including SBIRT, 
        and treatment.
            ``(24) Medication management.
            ``(25) Any other pediatric mental, emotional, or behavioral 
        health service determined appropriate by the Secretary.''.
    (b) Under Medicaid Managed Care Plans.--Section 1932(f) of such Act 
(42 U.S.C. 1396u-2(f)) is amended--
            (1) in the header, by inserting ``and Pediatric Mental, 
        Emotional, and Behavioral Health'' before ``Services'';
            (2) by inserting ``and pediatric mental, emotional, and 
        behavioral health services described in section 
        1902(a)(13)(D)'' after ``section 1902(a)(13)(C)''; and
            (3) by striking ``such section'' and inserting ``section 
        1902(a)(13)''.
    (c) Increase in Payment Using Increased FMAP.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended by adding at the end 
the following new subsection:
    ``(jj) Increased FMAP for Additional Expenditures for Pediatric 
Mental, Emotional, and Behavioral Health Services.--Notwithstanding 
subsection (b), with respect to the portion of the amounts expended for 
medical assistance for services described in section 1902(a)(13)(D) 
furnished on or after the date that is 180 days after date of enactment 
of this subsection and before October 1, 2027, and that is attributable 
to the amount by which the minimum payment rate required under such 
section (or, by application, section 1932(f)) exceeds the payment rate 
applicable to such services under the State plan as of the day before 
the date of the enactment of this subsection, the Federal medical 
assistance percentage for a State that is one of the 50 States or the 
District of Columbia shall be equal to 100 percent. The preceding 
sentence does not prohibit the payment of Federal financial 
participation based on the Federal medical assistance percentage for 
amounts in excess of those specified in such sentence.''.

SEC. 4. GUIDANCE TO STATES ON SUPPORTING MENTAL, EMOTIONAL, AND 
              BEHAVIORAL HEALTH SERVICES, AND ON THE AVAILABILITY OF 
              TELEHEALTH UNDER MEDICAID.

    (a) Mental, Emotional, and Behavioral Health Services.--Not later 
than 180 days after date of enactment of this Act, the Secretary of 
Health and Human Services shall issue guidance to States on how to 
expand the provision of mental, emotional, and behavioral health 
services covered by State plans (or waivers of such plans) under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.), including a 
description of best practices for effective programs, service provision 
for underserved communities, and recruitment and retention of 
providers.
    (b) Telehealth Services.--Not later than 1 year after date of 
enactment of this Act, the Secretary of Health and Human Services shall 
issue guidance to States on best practices to sustain and enhance the 
availability of telehealth services covered by State plans (or waivers 
of such plans) under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.).

SEC. 5. ENSURING CHILDREN RECEIVE TIMELY ACCESS TO CARE.

    (a) Guidance to States on Flexibilities To Ensure Provider Capacity 
To Provide Pediatric Mental, Emotional, and Behavioral Crisis Care.--
Not later than 60 days after the date of enactment of this Act, the 
Secretary of Health and Human Services shall provide guidance to States 
on existing flexibilities for hospitals and other providers under 
applicable laws, regulations, and guidance to support children in 
crisis or in need of intensive mental, emotional or behavioral health 
services.
    (b) Mandated Report to Congress Regarding Barriers to Repurposing 
of Beds, Space, and Staff To Address Pediatric Behavioral Health 
Needs.--
            (1) In general.--Not later than 120 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to the Congress a report with respect to 
        regulatory and legal barriers to care across the crisis 
        continuum that identifies solutions to facilitate flexibility 
        for children's hospitals and other providers of mental, 
        emotional, or behavioral health services.
            (2) Requirements.--In preparing a report under this 
        subsection, the Secretary of Health and Human Services shall 
        include in such report--
                    (A) a comprehensive list of laws, regulations, and 
                guidance impacting children's hospitals' and other 
                providers' ability to repurpose immediately beds, 
                space, and staff for children in need of mental, 
                emotional, or behavioral health services, including a 
                description of the rationale for each policy and 
                corresponding actions required to repurpose such beds, 
                space, and staff; and
                    (B) recommendations on how children's hospitals and 
                other providers can immediately expand access to 
                mental, emotional, and behavioral health services while 
                also ensuring high quality and safety.
    (c) Ensuring Consistent Review and State Implementation of Early 
and Periodic Screening, Diagnostic, and Treatment Services.--Section 
1905(r) of the Social Security Act (42 U.S.C. 1396d(r)) is amended by 
adding at the end the following: ``The Secretary shall, not later than 
July 1, 2022, and not later than January 1 each year thereafter, review 
implementation of the requirements of this subsection by States as they 
pertain to behavioral health services for children, including services 
provided by a managed care entity, identify and disseminate best 
practices for ensuring comprehensive coverage of services, identify 
gaps and deficiencies in meeting Federal requirements, and provide 
guidance to States on addressing identified gaps and disparities and 
meeting Federal coverage requirements in order to ensure children, 
including children without a mental health diagnosis, have access to 
behavioral health services.''.

SEC. 6. PROGRAMS TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE.

    Subpart V of part D of title III of the Public Health Service Act 
(42 U.S.C. 256 et seq.) is amended by adding at the end the following:

``SEC. 340A-1. PROGRAM TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE 
              INTEGRATION AND COORDINATION.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award 
grants, contracts, or cooperative agreements to eligible entities for 
the purpose of supporting pediatric behavioral health care integration 
and coordination within communities to meet local community needs.
    ``(b) Eligible Entities.--Entities eligible for grants under 
subsection (a) include--
            ``(1) health care providers, including family physicians, 
        pediatric medical sub-specialists, and surgical specialists;
            ``(2) children's hospitals;
            ``(3) facilities that are eligible to receive funds under 
        section 340E or 340H;
            ``(4) nonprofit medical facilities that predominantly treat 
        individuals under the age of 21;
            ``(5) rural health clinics and Federally qualified health 
        centers (as such terms are defined in section 1861(aa) of the 
        Social Security Act);
            ``(6) pediatric mental health and substance use disorder 
        providers, such as child and adolescent psychiatrists, 
        psychologists, developmental and behavioral pediatricians, 
        general pediatricians, advanced practice nurses, social 
        workers, licensed professional counselors, and other licensed 
        professionals that provide mental health and substance use 
        disorder services to patients under 21 years of age;
            ``(7) child advocacy centers described in section 
        214(c)(2)(B) of the Victims of Child Abuse Act of 1990;
            ``(8) school-based health centers; and
            ``(9) other entities as determined appropriate by the 
        Secretary.
    ``(c) Prioritization.--In making awards under subsection (a), the 
Secretary shall prioritize--
            ``(1) applicants that provide children and adolescents from 
        high need, rural, or under-resourced communities with services 
        across the continuum of children's mental health and substance 
        use disorder care; and
            ``(2) applicants that predominantly provide care to 
        children and adolescents that demonstrate plans to utilize 
        funds to expand provision of care to children, adolescents, and 
        youth under age 21.
    ``(d) Use of Funds.--Activities that may be funded through an award 
under subsection (a) include--
            ``(1) increasing the capacity of pediatric practices, 
        family medicine practices, and school-based health centers to 
        integrate pediatric mental, emotional, and behavioral health 
        services into their practices including through co-location of 
        mental, emotional, and behavioral health providers;
            ``(2) training for non-clinical pediatric health care 
        workers, including care coordinators and navigators, on child 
        and adolescent mental health and substance use disorder, 
        trauma-informed care, and local resources to support children 
        and caregivers;
            ``(3) expanding evidence-based, integrated models of care 
        for pediatric mental health and substance use disorder 
        services;
            ``(4) pediatric practice integration for the provision of 
        pediatric mental health and substance use disorder services;
            ``(5) addressing surge capacity for pediatric mental health 
        and substance use disorder needs;
            ``(6) providing pediatric mental, emotional, and behavioral 
        health services to children as delivered by mental health and 
        substance use disorder professionals utilizing telehealth 
        services;
            ``(7) establishing or maintaining initiatives to allow more 
        children to access care outside of emergency departments, 
        including partial hospitalization, step down residency 
        programs, and intensive outpatient programs;
            ``(8) supporting, enhancing, or expanding pediatric mental 
        health and substance use disorder preventive and crisis 
        intervention services;
            ``(9) establishing or maintaining pediatric mental health 
        and substance use disorder urgent care or walk-in clinics;
            ``(10) establishing or maintaining community-based 
        pediatric mental health and substance use disorder initiatives, 
        such as partnerships with schools and early childhood education 
        programs;
            ``(11) addressing other access and coordination gaps to 
        pediatric mental health and substance use disorder services in 
        the community for children; and
            ``(12) supporting the collection of data on children and 
        adolescents' mental health needs, service utilization and 
        availability, and demographic data, to capture community needs 
        and identify gaps and barriers in children's access to care, in 
        a manner that protects personal privacy, consistent with 
        applicable Federal and State privacy laws.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $500,000,000 for each of fiscal 
years 2023 through 2027.

``SEC. 340A-2. PEDIATRIC BEHAVIORAL HEALTH WORKFORCE TRAINING PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award 
grants, contracts, or cooperative agreements to eligible entities for 
the purpose of supporting evidence-based pediatric mental health and 
substance use disorder workforce training.
    ``(b) Eligible Entities.--Entities eligible for grants under 
subsection (a) include--
            ``(1) children's hospitals;
            ``(2) facilities that are eligible to receive funds under 
        section 340E or 340H;
            ``(3) nonprofit medical facilities that predominantly treat 
        individuals under the age of 21;
            ``(4) rural health clinics and Federally qualified health 
        centers (as such terms are defined in section 1861(aa) of the 
        Social Security Act);
            ``(5) entities that employ mental health and substance use 
        disorder professionals, such as child and adolescent 
        psychiatrists, psychologists, developmental and behavioral 
        pediatricians, general pediatricians, advanced practice nurses, 
        social workers, licensed professional counselors, or other 
        licensed professionals that provide mental health or substance 
        use disorder services to patients under 21 years of age; and
            ``(6) other pediatric health care providers as determined 
        appropriate by the Secretary.
    ``(c) Use of Funds.--Activities that may be supported through an 
award under subsection (a) include the following:
            ``(1) Training to enhance the capabilities of the existing 
        pediatric workforce, including pediatricians, primary care 
        physicians, advanced practice registered nurses, and other 
        pediatric health care providers, including expanded training in 
        pediatric mental health and substance use disorders, and 
        culturally and developmentally appropriate care for children 
        with mental health conditions.
            ``(2) Training to support multi-disciplinary teams to 
        provide pediatric mental health and substance use disorder 
        treatment, including through integrated care models.
            ``(3) Initiatives to accelerate the time to licensure 
        within the pediatric mental health or substance use disorder 
        workforce.
            ``(4) Activities to expand recruitment and retention, 
        increase workforce diversity, or enhance workforce training for 
        critical pediatric mental health professions, including--
                    ``(A) child and adolescent psychiatrists;
                    ``(B) psychiatric nurses;
                    ``(C) psychologists;
                    ``(D) family therapists;
                    ``(E) social workers;
                    ``(F) mental health counselors;
                    ``(G) developmental and behavioral pediatricians;
                    ``(H) pediatric substance use disorder specialists; 
                and
                    ``(I) other mental health care providers as 
                determined appropriate by the Secretary.
    ``(d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $100,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 7. INCREASING FEDERAL INVESTMENT IN PEDIATRIC BEHAVIORAL HEALTH 
              SERVICES.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

    ``TITLE XXXIV--ASSISTANCE FOR CONSTRUCTION AND MODERNIZATION OF 
   CHILDREN'S MENTAL HEALTH AND SUBSTANCE USE DISORDER INFRASTRUCTURE

``SEC. 3401. INCREASING FEDERAL INVESTMENT IN PEDIATRIC BEHAVIORAL 
              HEALTH SERVICES.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award 
grants, contracts, or cooperative agreements to eligible entities for 
the purpose of improving their ability to provide pediatric behavioral 
health services, including by--
            ``(1) constructing or modernizing sites of care for 
        pediatric behavioral health services;
            ``(2) expanding capacity to provide pediatric behavioral 
        health services, including enhancements to digital 
        infrastructure, telehealth capabilities, or other improvements 
        to patient care infrastructure;
            ``(3) supporting the reallocation of existing resources to 
        accommodate pediatric behavioral health patients, including by 
        converting or adding a sufficient number of beds to establish 
        or increase the hospital's inventory of licensed and 
        operational, short-term psychiatric and substance use inpatient 
        beds; and
            ``(4) addressing gaps in the continuum of care for 
        children, by expanding capacity to provide intermediate levels 
        of care, such as intensive outpatient services, partial 
        hospitalization programs, and day programs that can prevent 
        hospitalizations and support children as they transition back 
        to their homes and communities.
    ``(b) Eligibility.--To be eligible to seek an award under this 
section, an entity shall be a hospital or rural health clinic that 
predominantly treats individuals under the age of 21, including any 
hospital that receives funds under section 340E.
    ``(c) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $2,000,000,000 for each of 
fiscal years 2023 through 2027.
    ``(d) Supplement, Not Supplant.--Funds provided under this section 
shall be used to supplement, not supplant Federal and non-Federal funds 
available for carrying out the activities described in this section.
    ``(e) Reporting.--
            ``(1) Reports from award recipients.--Not later than 180 
        days after the completion of activities funded by an award 
        under this section, the entity that received such award shall 
        submit a report to the Secretary on the activities conducted 
        using funds from such award, and other information as the 
        Secretary may require.
            ``(2) Reports to congress.--Not later than one year, the 
        Secretary shall submit to the Committee on Energy and Commerce 
        of the House of Representatives and the Committee on Health, 
        Education, Labor, and Pensions of the Senate a report on the 
        projects and activities conducted with funds awarded under this 
        section, and the outcome of such projects and activities. Such 
        report shall include--
                    ``(A) the number of projects supported by awards 
                made under this section;
                    ``(B) an overview of the impact, if any, of such 
                projects on pediatric health care infrastructure, 
                including any impact on access to pediatric mental 
                health and substance use disorder services;
                    ``(C) recommendations for improving the investment 
                program under this section; and
                    ``(D) any other considerations as the Secretary 
                determines appropriate.''.
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